Description

Description:

Job Summary:

Coordinates with physicians, staff, and non-Kaiser providers/facilities regarding patient care/population based management for patients in specifically defined geriatric or other specifically defined patient populations (e.g., patients with a specific chronic disease, high risk patients) in order to plan and implement a comprehensive, mutli-disciplinary approach to manage health conditions, utilization of resources and protocols, patient self-care, implementation and evaluation of treatment plan across the care continuum (primary, secondary, tertiary and continued care). In conjunction with physicians, develops treatment plan, monitors care, makes recommendations for alternative levels of care, identifies cost-effective protocols and care paths and develops guidelines for care that may require coordination across systems of multiple providers/services.

Essential Responsibilities:

• Plans, develops, assesses and evaluates care provided to members.
• In conjunction with primary care and specialist physicians, evaluates and develops baseline medical and psychosocial evaluations and individualized patient care/treatment plans.
• Recommends alternative levels of care and ensures compliance with federal, state, and local requirements.
• Makes assessments of physiological and or functional status utilizing protocols.
• Initiates appropriate diagnostic testing/screening and interventions.
• Develops individualized patient/family education plan focused on self-management; delivers patient/family education specific to a disease state.
• Implements strategies to target/assess risk factors and achieve and ensure patient follow-up according to clinical and strategic measures/outcomes.
• Produces population based reports on outcomes specific to defined patient populations.
• Participates with healthcare team/providers in actualizing outcomes by planning, evaluating and implementing decisions and strategies to achieve predetermined cost, clinical, quality, utilization and service outcomes.
• Develops and maintains case management policies and procedures.
• Coordinates care/services with utilization and/or quality reviewers and monitors level and quality of care.
• Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals/transfers as needed for outside services for patients/families.
• Consults with internal and external physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement.
• Arranges and monitors follow-up appointments.
• Encourages member to follow prescribed course of care (e.g., drug therapy, physical therapy).
• Makes referrals to appropriate community services and outside providers.
• Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum.
• Develops and collects data; trends utilization of health care resources.
• Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
• Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies.
• Acts as liaison for outside agencies, non-plan facilities, and outside providers.
• Coordinates repatriation of patients and monitors their quality of care.

Basic Qualifications:

Experience

• Basic Quallifications:

• N/A.

Education

• Graduate of an academic institution accredited by the Council on Social Work Education and a Masters degree in Social Work.

License, Certification, Registration

• N/A

Additional Requirements:

• Demonstrated knowledge of case management, discharge planning, transfer coordination; TJC and other federal/state/local regulations.
• Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:

• Minimum two (2) years of case management experience with the population to be case managed preferred.
• Current and valid LCSW highly preferred.

Primary Location: California,Downey,Downey Boeing - Independence Park
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:30 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard Worker Location: Flexible
Employee Status: Regular
Employee Group/Union Affiliation: NUE-SCAL-01|NUE|Non Union Employee
Job Level: Individual Contributor
Department: Independence Park - Case Management - 0806
Pay Range: $103700 - $134200 / year Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data and a candidate's years of relevant work experience, education, certifications, skills, and geographic location. Travel: No Flexible: Work location is on-site at a KP location, with the flexibility to work from home. Worker location must align with Kaiser Permanente's Authorized States policy. Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.

For jobs where work will be performed in unincorporated LA County, the employer provides the following statement in accordance with the Los Angeles County Fair Chance Ordinance. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment:

Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state, and local laws and regulations, accreditation, and licensure requirements (where applicable), and Kaiser Permanente's policies and procedures.

Models and reinforces ethical behavior in self and others in accordance with the Principles of Responsibility, adheres to organizational policies and guidelines; supports compliance initiatives; maintains confidences; admits mistakes; conducts business with honesty, shows consistency in words and actions; follows through on commitments.

Job duties with at least occasional or possible access to: (1) patients, the general public, or other employees; (2) confidential protected health information and other confidential KP information (including employee, proprietary, financial or trade secret information); (3) KP property and assets, for example, electronic assets, medical instruments, or devices; (4) controlled substances regulated by federal law or potentially subject to diversion.

Requisition #: 1391942

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